THE EIGHTEENTH CENTURY AND THE BIRTH OF PSYCHIATRY

However, psychiatry as a medical discipline only emerged in the eighteenth century. It was a child of the European Enlightenment, whose leading philosophers challenged the notion that human beings should be guided by divine authority or deference to tradition. Instead, individuals would solve their problems by the application of reason. In like manner, the mysteries of madness would be unravelled by medical science. In the second half of the eighteenth century, the Edinburgh medical school became the dominant force in Europe.³ It held that the nervous system was the prime operator of bodily function, a concept that overturned the teachings of the Dutch school, which held that the vascular system was pre-eminent.

The age of nerves and melancholy

The eighteenth century has been described as 'The Age of Nerves' because the incidence of nervous disease was perceived to be increasing alarmingly.⁴ Many eighteenth-century luminaries, such as Samuel Johnson, James Boswell, Robert Burns, David Hume, Adam Smith and Tobias Smollett suffered from nerves. The most famous popular treatise on nerves during the period was The English Malady by the Scottish physician George Cheyne, who advised that it was only the well-to-do who suffered from lowness of spirits because their nerves were much more refined than the lower orders.⁵ Another physician, William Stuckley, felt that melancholy especially afflicted artists, poets and philosophers.⁶

The eighteenth century has also been called 'The Age of Melancholy' because so many poets of the period, such as Blair, Cowper, Gray and Young, were preoccupied with the theme of melancholy.⁷ A key novel of the era was Johann Goethe's The Sorrows of Young Werther, which recounted the sufferings and eventual suicide of a young man. In his autobiography, Goethe remembered the cult of melancholic selfabsorption which characterised the period of the novel's publication. Speaking of the popularity of the work of the English poets of melancholy, Goethe writes:

These earnest poems, which undermined human nature, were the favourites that we chose above all the others, one seeking the lighter elegiac lament, which accorded with his temper, another the burdensome, hopelessness of despair . . . everyone believed that he had the right to be as melancholy as the Prince of Denmark . . .⁸

In the Lives of the English Poets, Samuel Johnson catalogued the woes that befell the lot of the poet: Sir John Denham became temporarily insane; John Gay was often sunk low in spirits; Jonathan Swift went mad in his last years; and William Collins suffered from bouts of insanity. In addition, Milton was blind, Matthew Prior was deaf, the Earl of Rochester died prematurely from a life of dissipation, Richard Savage led an irregular life and expired in prison, while many others struggled with poverty and neglect.⁹ Johnson's book was a favourite of Robert Burns, who declared: 'There is not among all the Martyrologies that ever were penned, so rueful a narrative as Johnson's Lives of the Poets.

Burns' letters convey his own struggles with despondency, for example:

I am groaning under the miseries of a diseased nervous System; a System of all others the most essential to our happiness - or the most productive of our Misery. - For now near three weeks I have been so ill with a nervous head-ach, that I have been obliged to give up for a time my Excise-books, being scarce able to lift my head, much less to ride once a week over ten muir Parishes.¹⁰

Some took a sign of a superior sensibility for being prone to low spirits. This was a sentiment which James Boswell examined in his column, The Hypochondriak. Boswell began by examining this statement by Aristotle: 'Why is it that all men who have excelled in philosophy, in politicks, in poetry, or in the arts, have been subject to melancholy?' Boswell comments:

Aristotle . . . appears to have admitted the opinion that melancholy is the concomitant of distinguished genius . . . We Hypochondriaks may be glad to accept of this compliment from so great a master of human nature, and to console ourselves in the hour of gloomy distress, by thinking that our suffering mark our superiority.¹¹

In the essay, Boswell does go on to undermine the notion that melancholy was always accompanied by superiority but he appears to have a sneaking sympathy for the idea nevertheless. While Boswell might have been tempted to congratulate himself and his fellow sufferers on being a cut above the rest by virtue of their heightened sensibility, Samuel Johnson, who was also afflicted with depressed spirits, upbraided Boswell. Johnson did not feel that melancholy conferred superiority and advised his biographer: 'Read Cheyne's English Malady but do not let him teach you a foolish notion that melancholy is proof of acuteness'.¹² In Boswell's great biography of his friend, we read their many discussions about low spirits and how to counter them. Johnson favoured stoicism, whilst Boswell felt it was good to talk. In his novel, The History of Rasselas, Prince of Abissinia, Johnson's hero sets out on an adventure to attain happiness only to find that such a state is largely illusory.